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| Item Number | Policy/Procedure Date Posted Comment Period Closed Status | Date Posted Comment Period Closed Status | Comment Period Closed Status | Status | Document Links |
|---|---|---|---|---|---|
| 2025-PHARM-121 | Palivizumab Criteria | 9/2/25 | 10/17/25 | Pending | Palivizumab Criteria |
| 2025-HUMANA-MED-129 | Pemetrexed, 10 mg – HCPCS codes J9292, J9294, J9305, J9322 and J9323 | 8/14/25 | 9/28/25 | Pending | Pemetrexed, 10 mg – HCPCS codes J9292, J9294, J9305, J9322 and J9323 |
| 2025-UHC-MED-251 | Encelto | 8/12/25 | 9/26/25 | Pending | Encelto |
| 2025-UHC-MED-252 | Denosumab-prolia-xgeva | 8/12/25 | 9/26/25 | Pending | Denosumab-prolia-xgeva |
| 2025-UHC-MED-253 | Reblozyl | 8/12/25 | 9/26/25 | Pending | Reblozyl |
| 2025-UHC-MED-254 | Rituxan-rituximab | 8/12/25 | 9/26/25 | Pending | Rituxan-rituximab |
| 2025-HB-MED-544 | Enhertu (fam-trastuzumab deruxtecan-nxki) | 8/12/25 | 9/26/25 | Pending | Enhertu (fam-trastuzumab deruxtecan-nxki) |
| 2025-LHCC-MED-852 | Nipocalimab-aahu (Imaavy) | 8/12/25 | 9/26/25 | Pending | Nipocalimab-aahu (Imaavy) |
| 2025-LHCC-MED-853 | Retifanlimab-dlwr (Zynyz) | 8/12/25 | 9/26/25 | Pending | Retifanlimab-dlwr (Zynyz) |
| 2025-HB-MED-545 | Imaavy (nipocalimab) | 8/12/25 | 9/26/25 | Pending | Imaavy (nipocalimab) |
| 2025-HB-MED-546 | Bevacizumab for Non-Ophthalmologic Indications | 8/12/25 | 9/26/25 | Pending | Bevacizumab for Non-Ophthalmologic Indications |
| 2025-HB-MED-547 | Denosumab | 8/12/25 | 9/26/25 | Pending | Denosumab |
| 2025-HB-MED-550 | Amvuttra (vutrisiran) | 8/12/25 | 9/26/25 | Pending | Amvuttra (vutrisiran) |
| 2025-HB-MED-551 | Vascular Endothelial Growth Factor (VEGF) Inhibitors | 8/12/25 | 9/26/25 | Pending | Vascular Endothelial Growth Factor (VEGF) Inhibitors |
| 2025-LHCC-MED-823 | Datopotamab deruxtecan-dlnk (Datroway) | 8/12/25 | 9/26/25 | Pending | Datopotamab deruxtecan-dlnk (Datroway) |
| 2025-LHCC-MED-845 | Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) | 8/12/25 | 9/26/25 | Pending | Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) |
| 2025-LHCC-MED-846 | Pegunigalsidase alfa-iwxj (Elfabrio) | 8/12/25 | 9/26/25 | Pending | Pegunigalsidase alfa-iwxj (Elfabrio) |
| 2025-LHCC-MED-847 | Denosumab (Xgeva and Biosimilars) | 8/12/25 | 9/26/25 | Pending | Denosumab (Xgeva and Biosimilars) |
| 2025-LHCC-MED-848 | Rituximab (Rituxan), Rituximab-Hyaluronidase (Rituxan Hycela), and Biosimilars | 8/12/25 | 9/26/25 | Pending | Rituximab (Rituxan), Rituximab-Hyaluronidase (Rituxan Hycela), and Biosimilars |
| 2025-LHCC-MED-849 | Letermovir (Prevymis) | 8/12/25 | 9/26/25 | Pending | Letermovir (Prevymis) |
| 2025-LHCC-MED-850 | Desmopressin Acetate (DDAVP) | 8/12/25 | 9/26/25 | Pending | Desmopressin Acetate (DDAVP) |
| 2025-LHCC-MED-851 | Treprostinil (Orenitram, Remodulin, Tyvaso, Yutrepia) | 8/12/25 | 9/26/25 | Pending | Treprostinil (Orenitram, Remodulin, Tyvaso, Yutrepia) |
| 2025-UHC-MED-247 | Testosterone replacement or supplementation therapy | 8/7/25 | 9/21/25 | Pending | Testosterone replacement or supplementation therapy |
| 2025-HUMANA-MED-125 | Prior Authorization List-State Submission | 8/7/25 | 9/21/25 | Pending | Prior Authorization List-State Submission |
| 2025-HUMANA-MED-126 | Collagenase clostridium histolyticum – HCPCS code J0775 (8419) | 8/7/25 | 9/21/25 | Pending | Collagenase clostridium histolyticum – HCPCS code J0775 (8419) |
| 2025-HUMANA-MED-127 | Golimumab, 1 mg – HCPCS code J1602 (8515) | 8/7/25 | 9/21/25 | Pending | Golimumab, 1 mg – HCPCS code J1602 (8515) |
| 2025-HUMANA-MED-128 | esketamine nasal spray – HCPCS code S0013 (8502) | 8/7/25 | 9/21/25 | Pending | esketamine nasal spray – HCPCS code S0013 (8502) |
| 2025-PHARM-119 | Palivizumab Criteria | 8/4/25 | 9/18/25 | Pending | Palivizumab Criteria |
| 2025-PHARM-120 | Palivizumab Request Form | 8/4/25 | 9/18/25 | Pending | Palivizumab Request Form |
| 2025-LHCC-MED-831 | Nivolumab (Opdivo), Nivolumab Hyaluronidase-nvhy (Opdivo Qvantig) | 7/28/25 | 9/11/25 | Pending | Nivolumab (Opdivo), Nivolumab Hyaluronidase-nvhy (Opdivo Qvantig) |
| 2025-LHCC-MED-824 | Avacincaptad pegol (Izervay) | 7/25/25 | 9/8/25 | Pending | Avacincaptad pegol (Izervay) |
| 2025-LHCC-MED-825 | Hyaluronate Derivatives | 7/25/25 | 9/8/25 | Pending | Hyaluronate Derivatives |
| 2025-LHCC-MED-826 | Furosemide (Furoscix) | 7/25/25 | 9/8/25 | Pending | Furosemide (Furoscix) |
| 2025-LHCC-MED-827 | Efgartigimod Alfa-fcab (Vyvgart) | 7/25/25 | 9/8/25 | Pending | Efgartigimod Alfa-fcab (Vyvgart) |
| 2025-LHCC-MED-828 | Iptacopan (Fabhalta) | 7/25/25 | 9/8/25 | Pending | Iptacopan (Fabhalta) |
| 2025-LHCC-MED-829 | Dostarlimab-gxly (Jemperli) | 7/25/25 | 9/8/25 | Pending | Dostarlimab-gxly (Jemperli) |
| 2025-LHCC-MED-830 | Daptomycin (Cubicin, Cubicin RF, Dapzura RT) | 7/25/25 | 9/8/25 | Pending | Daptomycin (Cubicin, Cubicin RF, Dapzura RT) |
| 2025-LHCC-MED-832 | Ciltacabtagene Autoleucel (Carvykti) | 7/25/25 | 9/8/25 | Pending | Ciltacabtagene Autoleucel (Carvykti) |
| 2025-LHCC-MED-833 | Vutrisiran (Amvuttra) | 7/25/25 | 9/8/25 | Pending | Vutrisiran (Amvuttra) |
| 2025-UHC-MED-249 | Kebilidi | 7/24/25 | 9/7/25 | Pending | Kebilidi |
| 2025-UHC-MED-250 | FcRn-blockers | 7/24/25 | 9/7/25 | Pending | FcRn-blockers |
| 2025-LHCC-MED-834 | Omacetaxine (Synribo) | 7/24/25 | 9/7/25 | Pending | Omacetaxine (Synribo) |
| 2025-LHCC-MED-835 | Isatuximab-irfc (Sarclisa) | 7/24/25 | 9/7/25 | Pending | Isatuximab-irfc (Sarclisa) |
| 2025-LHCC-MED-836 | Ramucirumab (Cyramza) | 7/24/25 | 9/7/25 | Pending | Ramucirumab (Cyramza) |
| 2025-LHCC-MED-837 | Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) | 7/24/25 | 9/7/25 | Pending | Bevacizumab (Alymsys, Avastin, Mvasi, Vegzelma, Zirabev) |
| 2025-LHCC-MED-838 | Inotuzumab Ozogamicin (Besponsa) | 7/24/25 | 9/7/25 | Pending | Inotuzumab Ozogamicin (Besponsa) |
| 2025-LHCC-MED-839 | Nadofaragene Firadenovec-vncg (Adstiladrin) | 7/24/25 | 9/7/25 | Pending | Nadofaragene Firadenovec-vncg (Adstiladrin) |
| 2025-LHCC-MED-840 | Amivantamab-vmjw (Rybrevant) | 7/24/25 | 9/7/25 | Pending | Amivantamab-vmjw (Rybrevant) |
| 2025-LHCC-MED-841 | Tremelimumab-actl (Imjudo) | 7/24/25 | 9/7/25 | Pending | Tremelimumab-actl (Imjudo) |
| 2025-LHCC-MED-842 | Paclitaxel, Protein-Bound (Abraxane) | 7/24/25 | 9/7/25 | Pending | Paclitaxel, Protein-Bound (Abraxane) |
| 2025-LHCC-MED-843 | Fam-Trastuzumab Deruxtecan-nxki (Enhertu) | 7/24/25 | 9/7/25 | Pending | Fam-Trastuzumab Deruxtecan-nxki (Enhertu) |
| 2025-LHCC-MED-844 | Pembrolizumab (Keytruda) | 7/24/25 | 9/7/25 | Pending | Pembrolizumab (Keytruda) |
Managed Care Pharmacy and Medical Drug Policies
In accordance with La. R.S. 46:460.51, et seq., prior to adopting, approving, amending, or implementing certain policies or procedures, LDH will publish the proposed policy or procedure for the purpose of soliciting public comments. For this purpose, a policy or procedure, as defined by the statute, shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.
The following table contains the LDH and managed care organization pharmacy and medical drug policies that are open for public comment. To provide feedback, please complete this form. Refer to the links below the table for archived postings and public comments.
Related Info
- Previously posted for public comment
- Managed Care Pharmacy and Medical Drug Policies - Archive (2024)
- Managed Care Pharmacy and Medical Drug Policies - Archive (2023)
- Managed Care Pharmacy and Medical Drug Policies - Archive (2022)
- Managed Care Pharmacy and Medical Drug Policies - Archive (2021 and prior)
- Public comments submitted